Defining Deserts and Swamps. Food deserts are areas or neighborhoods that have limited access to healthy food choices and may be solely dependent on convenience stores or fast-food restaurants, where going hungry and not having enough to eat may be residents’ biggest concerns. A food swamp, on the other hand, is an area or neighborhood that has access to healthy foods, but these options are outnumbered by much less expensive food outlets with few or no healthy options. Poor diet quality, rather than going hungry, is the primary concern. For someone on a tight budget, the choices are clear, but less expensive often translates to less healthy. Some researchers have used the term “food mirage” to describe areas where healthy food choices are readily available, but out of reach financially for a significant portion of the population that lives there.

Experts have suggested that part of the problem is that supermarket chains offering healthy food choices may lack a vested interest to remain in low-income areas, where residents’ budgets don’t allow for the purchase of high-priced fresh fruits and vegetables and may shut down if most people in the area opt for less expensive food outlets, further restricting healthy food choices available to them.

Health Risks. “Both food deserts and food swamps pose health risks,” says Whitney Linsenmeyer, PhD, RD, LD, spokesperson for the Academy of Nutrition and Dietetics and assistant professor of nutrition at Saint Louis University. Studies have found that living in food swamps or food deserts is associated with increased rates of obesity, stroke (especially in older people), and some types of cancer. One study found that the death rate from cancers overall was 77 percent greater in counties with high food-swamp scores, meaning areas where fast-food outlets far outnumbered supermarkets and other fresh food options. The death rate from obesity-related cancers (breast, colorectal, endometrial, esophageal, gallbladder, stomach, liver, kidney, pancreas, ovaries, and thyroid) was 59 percent greater in counties with high food-desert scores, areas where few health food options were available. Another study in the International Journal of Environmental Research and Public Health found that food swamps better predicted obesity than food deserts. Researchers have even found that pregnant women living in areas identified as being food deserts were more likely to develop gestational diabetes, a type of diabetes that is diagnosed for the first time during pregnancy and that can have a negative effect on the health of both mother and baby. One study even found that living in a food desert had a negative effect on patients’ recovery after surgery for colorectal cancer.

While diet is often cited as a major “modifiable risk factor” for preventing diseases, like cardiovascular disease and cancer, if healthy foods are not available, or are not financially feasible, choosing healthy foods may be not be a realistic option.

Bottom Line. Short of moving to an area where healthy food choices are affordable and abundant, education is key. If you live in a food desert or a food swamp, it’s important to learn about realistic healthy, affordable food choices. If you’re able to identify healthier choices, Linsenmeyer recommends stocking up as far as your pantry space and budget allows. While fast food restaurants and corner markets typically offer far more unhealthy options than healthy ones, most do offer one or two healthier choices, such as canned beans, baked potatoes, grilled chicken breasts, veggies, sandwiches, yogurt parfaits, and kids’ meals for smaller portion sizes. Bottled water or unsweetened drinks cost the same as sugary sodas. At fast food outlets, if you opt for the typical menu items, forgo extras like double meat, cheese, or bacon on your burger.

While they’re not an option for everyone, a backyard garden or establishing a community garden can offer greater access to healthy food. Linsenmeyer says, “If you have a little patch of yard, or even a windowsill with good light, you may be able to grow some of your own fresh food at home, relying less on what the neighborhood grocer has (or doesn’t have) to offer.”

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Abdominal obesity (a waist circumference of more than 35 inches in women and 40 inches in men) is a well-established risk factor for coronary heart disease (CHD), the leading cause of death and disability in the United States. Scientists have found genetic markers associated with elevated risk for developing abdominal obesity. But genetic susceptibility may not doom an individual to higher CHD risk.

A large observational study assessed the genetic risk for abdominal obesity (measured by waist-to-hip ratio) for 280,000 British participants. They also looked at participants’ adherence to five healthy lifestyle factors: getting regular physical activity, not currently smoking, consuming a healthy dietary pattern, drinking alcohol less than three times a week, and getting seven to nine hours of sleep a day. They then looked for instances of CHD over an average of almost 14 years of followup. They found that, on average, individuals who had high or medium genetic risk of abdominal obesity but adhered to a healthy lifestyle had a lower risk of developing CHD, compared with those who had low genetic risk and an unhealthy lifestyle.

Genes are not always the end-all when it comes to health. Lifestyle choices are powerful— for better or for worse.

Gastrointestinal Side Effects from Popular Weight Loss Drugs are Rare, but Real

Glucagon-like peptide 1 (GLP-1) receptor agonists have been used for decades to treat type 2 diabetes and are now being used for weight loss (see December 2023 issue). It is known that these medications increase risk for gastrointestinal adverse events in patients with type 2 diabetes, but the newness of their use in people without diabetes means we have little data on side effects in that population.

In a study published after our December issue was written, researchers looked at a random sample of 16 million people with obesity but not diabetes who were prescribed a GLP-1 receptor agonist or the drug bupropionnaltrexone, a weight loss drug that is not a GLP-1 agonist. Incidence of gallbladder or bile duct (biliary) disease, inflammation of the pancreas (pancreatitis), bowel obstruction, or gastroparesis (slow stomach emptying) were recorded.

Compared to the bupropion-naltrexone, use of GLP-1 agonists was associated with higher risk of pancreatitis, bowel obstruction, and gastroparesis, but not biliary disease. These adverse events were extremely rare. For example, the risk of developing pancreatitis when taking the GLP-1 agonist semaglutide (the active ingredient in Wegovy and Ozempic) was 4.6 per 1,000 person-years, compared to 1.0 for users of bupropion-naltrexone. Pancreatitis risk in individuals taking liraglutide (the GLP-1 agonist that is the active ingredient in the diabetes drugs Victoza and Saxenda) was 7.9 per 1000 person-years.

While risk is low, people considering taking GLP-1 agonists for weight loss should discuss the risks and options with their healthcare provider before deciding to use these drugs.

Red Meat Intake Associated with Risk for Type 2 Diabetes

Current dietary guidelines recommend limiting intake of red meats (beef, pork, and lamb), primarily due to their content of saturated fat, which increases risk for heart disease. The results of a comprehensive new study suggest another reason to limit red meat intake—risk for type 2 diabetes.

The study gathered frequency of red meat intake from over 200,000 U.S. adults and documented type 2 diabetes cases in over two decades of follow-up. Higher intake of red meat, whether processed (like bacon, sausage, and deli meats) or unprocessed (like hamburger and steak), was associated with higher risk of developing type 2 diabetes. In general, the more red meat people ate, the higher their risk. Participants who ate the most total red meat had a 62 percent higher risk of developing the disease. (Importantly, these individuals also had poorer diet quality overall and were less likely to be physically active, which likely contributed to their increased risk.) Swapping a serving of red meat for a serving of dairy was also associated with lower risk. [Editor’s note: There are concerns about some components of full fat dairy increasing diabetes risk, so fat free and low-fat dairy products are best choices.]

This study adds to a large pool of information suggesting swapping red meat of all kinds for other protein choices (like poultry and dairy, but especially plant proteins like legumes) is a healthy choice.

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HNL: Two mediations have become popular options for the treatment of obesity. What are these drugs?

Dr. Siegel: Both Ozempic and Wegovy (which are made by the same manufacturer) contain the active ingredient semaglutide. Wegovy provides a higher dose. Both are delivered by self-injection.

Semaglutide mimics a naturally occurring hormone called GLP-1 that is released in the gut when we eat. GLP-1 prompts the body to produce more insulin and has actions in the appetite pathway in the brain. The doses of these medications are much higher than what the gut makes naturally. They seem to reduce cravings and dull the desire to eat.

In a trial published in 2021, adults with obesity taking semaglutide lost an average of almost 15 percent of their body weight in about one-and-a-half years. The placebo group lost an average of less than two-and-a-half percent. The only tool we have that leads to greater weight loss is bariatric surgery.

HNL: Are these drugs safe?

Dr. Siegel: Ozempic has been used to treat type 2 diabetes since 2017, so we have a lot of data showing this class of drugs is safe, at least at lower doses.

The most common side effects are nausea and constipation. This is a result of the drug slowing down the digestive tract. There may be some risk for a condition called gastroparesis, which is slow stomach emptying, but this seems to be very rare. The package insert also mentions risk of gallbladder or kidney problems, pancreatitis, increased heart rate, and, in patients with type 2 diabetes, increased risk of low blood sugar and changes in vision.

A lot of people are taking Wegovy and Ozempic now. That means we are gathering a lot of additional real-world information about side effects and safety.

HNL: Do people taking these drugs need to make lifestyle changes, too?

Dr. Siegel: The way I think of weight loss medications, in general, is as helpers to the lifestyle change approach. I recommend starting with self-monitoring, dietary changes, and increasing activity. If that is unsuccessful, we discuss adding “helpers” like surgery, meal replacement plans, and medication.

You can likely lose weight on semaglutide medications without changing your diet and activity behaviors, but these lifestyle changes will make the treatment more effective. Also, we don’t know if weight loss will have the same health benefits if one does not change their behaviors.

HNL: Do you have to take it forever?

Dr. Siegel: In one trial of Wegovy, people regained about two-thirds of the weight lost within a year of stopping the drug. Lifestyle changes can help maintain weight loss, but it’s unusual to maintain all weight loss once you stop any weight loss medication.

HNL: Who should consider taking these drugs?

Dr. Siegel: Wegovy is approved for use by adults and children aged 12 years and older with obesity and adults who are overweight and have weight-related medical problems like type 2 diabetes, high blood pressure, and/or sleep apnea. It is meant to be used in combination with calorie reduction and increased physical activity. Ozempic is not officially approved for weight loss, but many doctors prescribe it anyway. This is known as “offlabel” prescribing and is perfectly legal.

I feel strongly that these medications should only be taken while working with a weight management team or a Registered Dietitian.

People looking to lose weight should meet with their primary care provider or specialists at a weight loss clinic and develop a personalized, comprehensive plan for weight loss and maintenance.

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Too Much Dietary Fat. The recommended dietary fat intake is between 20% to 35% of calories, but the average intake in the US is just above the maximum recommended intake—36.1% for women and 35.6% for men. Following a popular keto-type diet generally calls for as much as 80% calories from fat, which generally results in weight loss, but consuming that much fat can be unhealthy. According to the University of Chicago Medicine, consuming the amount of fat recommended for keto diets can cause kidney stones, constipation, nutrient deficiencies, and increased risk of heart disease. A super high-fat diet is especially unsafe for those with any conditions involving their pancreas, liver, thyroid, or gallbladder. 

“A very high-fat diet also makes it difficult to meet recommended fiber goals,” says Julie Stefanski MEd, RDN, CSSD, LDN, CDCES, FAND, spokesperson for the Academy of Nutrition & Dietetics. In addition, she says, “Many meals Americans consume contain so much fat that it can wreak havoc on the fat digestion process, leading to diarrhea, abdominal pain, gallbladder issues, and acid reflux.”

Not All Fats Are the Same. Regardless of the amount of fat in your diet, or your health status, not all fats are created equal. For example, getting too much of manufactured trans fats can be especially harmful. The major dietary sources of trans fats in the diet are cakes, cookies, crackers, animal products, margarine, fried potatoes, potato chips, popcorn, and shortening. Despite being widespread in the diet, trans fats are not required by the body. According to the American Heart Association, trans fats in the diet can increase bad (LDL) cholesterol levels and lower good (HDL) cholesterol levels, increasing your risk of developing heart disease and stroke. Research has also suggested that trans fats are linked to colon cancer and weight gain—aside from any weight gain resulting from excess fat calories. A high trans-fat diet has also been associated with a higher risk of developing type 2 diabetes. Most experts have recommended eliminating trans fats from your diet, but if that’s not possible, keeping them to a minimum is healthy advice. The current recommendation is to keep trans fats to less than 1% of total energy intake, which translates to less than 2.2 g/day for a 2,000-calorie diet.

The same caveat applies to saturated fats—eating a diet high in saturated fats has been linked to cancer and cardiovascular disease. Like trans fats, too much saturated fat can cause cholesterol to build up in your arteries, raising your LDL cholesterol. Saturated fats have also been linked to inflammation, which is the trigger for a host of health conditions. Most saturated fats in the diet come from beef, lamb, pork, poultry, beef fat (tallow), lard and cream, butter, cheese, ice cream, coconut, palm oil, palm kernel oil, and some baked and fried foods. Recommendations for saturated fat intake range from less than 6% of calories to no more than 10% of calories. The American Heart Association recommends limiting saturated intake to no more than 6% of your total calories. If you need 2,000 calories a day, that lower limit translates to no more than 120 of those calories or 13 grams of fat from saturated fat.

Too Little Dietary Fat. Generally speaking, getting too little fat in the diet occurs far less often than getting too much. But following an extremely low-fat or fat-free diet in an effort to lose weight or reduce cardiovascular disease can cause several other health problems. That’s because healthy fats contain the essential fatty acids (EFAs), omega-3 fatty acids (fatty fish, flax, walnuts, canola oil) and omega-6 fatty acids (soybean, corn, and safflower oils; fish, eggs, walnuts, almonds, avocado), which the body is able to manufacture only in small amounts. Both require dietary sources. A low intake of fats and oils (less than amount corresponding to 20% of daily calorie intake) increases the risk of inadequate intakes of vitamin E and of EFAs and may contribute to unfavorable changes in HDL and triglycerides. Moreover, an extremely low-fat diet provides inadequate EFAs that are needed for cell growth, and skin and brain health. 

“Fat-soluble vitamins A, D, E and K can be challenging to come by when fat is avoided,” says dietitian Stefanski, “which can result in in low levels of vitamins that are typically absorbed more efficiently when dietary fat is present.” 

Bottom Line. It’s easy to consume too much fat and difficult to eliminate all fat, but neither is good for your health. Stick with the current recommendation of 20% to 35% of calories, focusing on healthy fats for maintaining good health.  

The post What Happens if You Have Too Much or Too Little Fat in Your Diet?  appeared first on University Health News.

A: Both gallstones and kidney stones are common and can exist without causing any pain or problems, unless they move or become large enough to block the normal flow of fluids in their associated organs. Kidney stones develop in the kidneys and can affect any part of your urinary tract. Key culprits to kidney stone formation include a diet high in sodium, red meat, oxalates (compounds found in such foods as leafy greens, some fruits, and nuts), and inadequate hydration. Symptoms include painful urination and sharp pain in the lower back or side that can travel down to your groin. Nausea and vomiting also may occur. Kidney stones may pass through the urinary tract (which can be quite painful). Treatments include medications to dissolve the stones, shockwave therapy, and surgical removal.

Gallstones form in the gallbladder, which is a small bag-like organ connected to the liver and intestines through tiny tubes called bile ducts. The gallbladder stores bile, a liquid produced by the liver that helps you digest fat. Most gallstones are composed of cholesterol. When the stones cause blockages, the most common symptoms occur suddenly after a fatty meal and include severe pain in the upper-right side of the abdomen that can last from 30 minutes to several hours, waxing and waning. Pain may radiate to the back or under the right shoulder; and nausea and vomiting may occur. If the pain is mild and intermittent, avoiding fatty foods and pain medications may prevent or reduce it. Small gallstones that don’t get stuck in the ducts can be passed through the stool. There are several nonsurgical treatments for dissolving and breaking apart the stones. If those aren’t an option, your doctor may recommend gallbladder removal, which is typically done through minimally invasive laparoscopic surgery. After removal the gallbladder is not missed because its function is basically as a storage bag. Without it, the bile flows directly from the liver to the small intestine. A high-fat diet can contribute to the formation of gallstones. A plant-based diet rich in fiber and magnesium may reduce the risk of formation.

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In the United States, pain is the symptom most commonly treated with acupuncture. Research published in February 2022 in the journal BMJ showed that, among studies that evaluated acupuncture treatments, conditions for which acupuncture was found to be most effective included neck, shoulder, and muscle pain, lower back pain, and pain caused by fibromyalgia. Other conditions that responded well to acupuncture were allergy symptoms, post-stroke aphasia (difficulty expressing and comprehending language), lactation issues after childbirth, and vascular dementia symptoms.

“Acupuncture also can be very effective for nausea and vomiting caused by chemotherapy, and as a preventive measure for migraines,” explains Victoria Chan Harrison, MD, assistant professor of rehabilitation medicine at Weill Cornell Medicine.

Traditional Chinese Medicine

Acupuncture is just one modality used in the practice of traditional Chinese medicine (TCM). TCM originated in China more than 2,000 years ago.

“TCM views the body as composed of different elements (water, fire, metal, wood, earth) and organ systems (kidney, bladder, heart, pericardium, triple heater, gallbladder, liver, lung, spleen) that need to be in balance at all times,” says Dr. Harrison.

In TCM, all of the body’s systems are connected through a network of channels called meridians. Another key aspect of TCM is Qi (pronounced “chee”), the vital life force or energy that flows throughout the body.

“The Chinese medical model also looks at environmental pathogens— wind, heat, damp, cold—that may affect the human body. When a pathogen ‘invades’ the body, it can impair the flow of both blood and Qi in the meridians. If imbalances, decreased blood flow, and Qi stagnation remains unchecked over a prolonged period of time, people can experience symptoms of what Western medicine calls diseases or illnesses,” says Dr. Harrison.

TCM Tools

The TCM practitioner’s toolkit includes different techniques to relieve symptoms and prevent disease manifestation. For example, ‘gua sha’ and ‘cupping’ both work on the myofascial layer—the connective tissue that lies beneath the skin—to increase circulation to the treated areas. Gua sha involves scraping the skin, often with a rounded, smooth stone or a special type of spoon, and cupping involves creating a vacuum to lift subcutaneous tissue.

“The goal is to improve the flow of Qi in areas of pain and at sites of muscle tissue injury. It is also often used to promote an immune response to fight a cold virus (in TCM, this is called ‘cold wind invasion’),” says Dr. Harrison.

Acupuncture and Chinese herbs can be used together to address the imbalances in the body’s five elements and in a particular organ system, as well as trying to expel pathogenic environmental effects, such as damp heat or cold wind.

Chinese Herbs

TCM practitioners may also use herb formulas to correct imbalances and promote the flow of Qi. Dr. Harrison explains that, traditionally, herb formulas were boiled to create a tea, but most modern Chinese herb formulas now come in the form of pills or tinctures.

Dr. Harrison advises caution when choosing Chinese herbs. She says, “Chinese herbal remedies can be problematic because of the lack of environmental and pharmacological regulation in the production, processing, and purity of the herbs. I typically recommend that Chinese herbal products be purchased from an American company that tests for impurities such as heavy metals to ensure quality of the product.”

If you are interested in being treated with TCM, ask your primary care physician for a recommendation, or visit the website of the National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org). Many states require a four-year master’s degree in acupuncture or traditional Oriental medicine and passing a board exam to become licensed.

Some insurance companies cover acupuncture for certain conditions; in 2020, Medicare and Medicaid began covering acupuncture as a treatment for chronic lower back pain.

The post Acupuncture: A Healing Practice Based on Balance and Energy Flow appeared first on University Health News.

Making the Decision to Have Elective Surgery

Elective surgery is surgery scheduled in advance to address health issues that are not immediately life threatening. Examples include joint replacement, gallbladder removal, cataract surgery, and hernia repair (see our July issue for more on the latter). A range of factors may influence a person’s thinking when it comes to proceeding with elective surgery. “Even if a procedure may seem like the obvious solution to a health problem, your decision about whether to go ahead with an operation really depends on what is important to you,” says Mount Sinai geriatrician Patricia Bloom, MD. “For example, if you have hip arthritis and are considering joint replacement, you might focus on getting fully mobile again so you can return to activities you enjoyed. But another person might focus more on how a long recovery period might affect their ability to care for a loved one who is in poor health. The decision to have hip replacement surgery may be very different for these two people. The benefit of the surgery, in terms of achieving the individual patient’s goal, may or may not outweigh the inconvenience of the surgery.”

In August 2021, the National Poll on Healthy Aging asked 2,110 people, ages 50 to 80, about their decision-making in regard to elective surgery. In all, 30 percent of the respondents said they had considered having or had elective surgery in the past five years. Among this group, nearly two-thirds reported having had concerns about potential pain or discomfort afterward, and 57 percent worried about how difficult their recovery might be. The potential out-of-pocket costs associated with the surgery loomed large for 46 percent of the respondents, while 34 percent were concerned about having someone to take care of them after their operation, and 17 percent said they worried about not being able to fulfill caregiving responsibilities for other people if they had surgery.

COVID-19 Concerns

Elective surgery has been in the spotlight during the COVID-19 pandemic because it often has been cancelled to free up hospital beds for people with serious COVID-19 symptoms. Among poll respondents who had considered having elective surgery during the past year, 46 percent were concerned about potential exposure to COVID-19 in the hospital. But those who were vaccinated against the virus were less likely to say they were very concerned than those who were unvaccinated. “The Centers for Disease Control and Prevention recommend that adults ages 50 and older get a second booster shot to better maintain their COVID-19 immunity,” Dr. Bloom notes. “While the vaccine is not a guarantee you will avoid COVID-19, there is strong evidence it can significantly decrease the risk of serious illness from the virus.”

Getting Informed

In the poll, most of the people who had considered elective surgery in the last five years had discussed the procedure with a surgeon or with their primary-care provider. “One of the benefits of elective surgery is that you have time to find out what the surgery entails and discuss any concerns you have with your health-care provider,” Dr. Bloom says. “It is important to get informed about the benefits, risks, and post-surgery considerations.” She adds that it also is vital to choose the right surgeon. “Older people contemplating surgery, especially the frail elderly or those with multiple underlying co-morbidities, would do well to have a surgeon who has performed the procedure on a lot of older patients, and/or have a geriatrician or internist who is attuned to the care of older adults involved in their post-operative care,” she says. “There are so many issues that might need to be addressed, like identifying and treating post-op delirium and cognitive changes as a result of anesthesia, post-op infections, the need for rapid mobilization and acute rehabilitation, and the possible adjustment of medication dosages, among other issues.” See What You Can Do for questions to ask your surgeon.

Be Cautious About Other Information Sources

About 33 percent of poll respondents said that family members and/or friends were sources of information, and 28 percent used the internet. Dr. Bloom says that talking to family and friends who may have had the same surgical procedure can be helpful. “They can give you a general idea of what to expect and recommend strategies to help you manage postsurgical pain and any temporary functional limitations that may interfere with your ability to carry out activities of daily living,” she says. “But keep in mind that not everybody experiences surgery in the same way. If a family member or friend doesn’t have positive memories of their procedure or recovery, try not to let it put you off surgery that might make a big difference to your life.” Likewise, be wary when it comes to seeking information online— stick to reputable sources, such as websites linked to large teaching institutions like Mount Sinai.

“Prehabilitation” Can Help

Some surgical departments and groups have “prehabilitation” clinics to help people prepare for elective surgery by addressing nutrition, exercise, tobacco use, and other factors that can affect recovery. Ask your surgeon if this service is available to you. And as well as preparing for your surgery, think about what you can do to make your recovery easier—see this month’s From the Editor for helpful tips.

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“Most gallstones are made of cholesterol, calcium salts, and bile,” says Rasa Zarnegar, MD, an associate professor of surgery at Weill Cornell Medicine. “A majority of people have gallstones, but most do not have any symptoms.”

Why Gallstones Form

The most common type of gallstones form when your liver excretes more cholesterol than your gallbladder can dissolve; the excess cholesterol can clump and form into hard particles, which gather more cholesterol, become larger, and eventually turn into stones. Gallstones also may form if your gallbladder does not empty completely or if your bile contains too much bilirubin.

A gallstone may be as small as a grain of sand or as large as a golf ball. If a gallstone becomes lodged in a duct, it can block the flow of bile and cause your gallbladder to become inflamed.

“Symptoms include abdominal pain, nausea, and vomiting. Sometimes, these symptoms start after a greasy meal, and they can last for several hours,” explains Dr. Zarnegar. “It is important to alert your doctor immediately if the pain does not go away after four to six hours, as this may require emergency surgery.”

Diagnostic Tests

If your doctor believes that you may have gallstones, he or she will probably order an abdominal ultrasound and/or a computed tomography (CT) scan. These tests create images of your gallbladder that can be examined for signs that gallstones are present. Other tests may help your doctor determine whether a gallstone is causing a blockage in your bile ducts. In these tests, a special dye is used to highlight your bile ducts.

Treatment Options

If you have gallstones that are causing symptoms, the most common treatment is cholecystectomy, or gallbladder removal. In most cases, the surgery is performed laparoscopically through small incisions in the abdomen and/ or navel (belly button). As with most surgeries, there is a small risk of bleeding and infection. If the surgeon discovers that scarring is extensive and/or the inflammation is severe, a more extensive surgery may be performed to ensure safety and minimize complications.

Following laparoscopic surgery, patients usually go home the same day and are able to resume all normal activities in a couple of days, with the exception of heavy lifting, which is prohibited for four weeks to allow for healing.

For many medical conditions, medication is the first line of treatment, and surgery is done only if all other treatment options fail. However, the reverse is true for gallbladder disease.

“Medications for gallbladder disease typically do not work,” explains Dr. Zarnegar. “There are some drugs that may dissolve the stones, but they are ineffective for most patients, and medication is an option only when the patient is unable to undergo surgery.”

Increased Risk

Factors associated with a higher risk of gallstones include:

• Having a family history of gallstones
• A diet high in fat and/or cholesterol and low in fiber
• Being overweight or obese
• Being female
• Taking medications that contain estrogen, such as birth control pills or hormone therapy drugs
• Being age 60 or older
• Having diabetes
• Being an American Indian or a Mexican American

If you have any of these risk factors, share that information with your doctor.

Dietary Changes May Help

Eating more plant foods and less red and processed meat can help prevent gallstones.

“A diet high in fiber and low in saturated fat keeps bile cholesterol in liquid form, which prevents gallstone formation,” advises Dr. Zarnegar. “In some studies, olive oil has been shown to reduce the risk of gallstones by helping reduce cholesterol levels in the blood and gallbladder.”

The post For Painful Gallstones, Gallbladder Removal May Be Necessary appeared first on University Health News.

The digestive system captures the nutrients in the foods and beverages we consume so we can absorb and use them for energy, growth, repair, and survival. Much of what is not absorbed is used by our gut bacteria. The remainder is sent on its way as feces. The parts of the gastrointestinal (GI) tract (mouth, esophagus, stomach, small intestine, large intestine including the colon, rectum, and anus) along with supporting organs (pancreas, gall bladder, and liver) each have a role to play along the way. A problem with any of these organs has the potential for wide-ranging health consequences.

The Gastrointestinal Tract. The GI tract is considered “outside” our body—a tube, from the mouth to the anus, with a lining that separates the inside of our body from the food we eat. The GI tract determines what is absorbed into our body and which nutrients enter the bloodstream to be shipped to where they are needed.

Plaut likens the GI tract to a slow-moving river. “The contents of the whole gut is dependent on motility, moving with muscles and nerves in a highly coordinated structure,” he explains. This movement, not too fast, not too slow, is essential to a well-functioning digestive system.

Various types of food processes, for example grinding, heating, and hydrating, can change nutrient availability and how that food behaves in the GI system.

➧➧ Mouth. The amazing journey we call digestion begins even before we put food into our mouths. Just the smell or sight (and sometimes thought) of food stimulates the secretion of saliva, making our mouths water. The first bites signal the production of increased secretion of saliva, which begins to break down starches with the enzyme salivary amylase as your teeth tear and grind the food into smaller, more digestible pieces. The food is moistened and lubricated so that it can be comfortably swallowed. Swallowing occurs in the throat (pharynx), which sends the food to the esophagus.

➧➧ Esophagus. The esophagus is a muscular tube about 10 to 13 inches long that connects the throat to the stomach. With each swallow, a valve in the upper part of the esophagus opens, allowing masticated food and liquid to enter. The mass of chewed food is then pushed downward by muscle contractions toward the lower esophageal valve, which opens to let the pieces of chewed food and liquid pass into the stomach.

➧➧ Stomach. The stomach breaks down food further and holds it until it’s ready to be sent to the small intestine. It expands when full and shrinks when empty. When your meal enters the stomach from the esophagus, it signals the release of gastric acid, which activates digestive enzymes to begin the breakdown of proteins. (Gastric acid also helps protect us from foodborne illness by destroying unwanted organisms.) The stomach muscles contract and relax to mix the enzymes and acids with the food you just ate. This end result is a mixture the consistency of a diluted paste.

➧➧ Small Intestine. The stomach contents moves into the small intestine, where it will be broken down even further. This is where most nutrients are absorbed, including proteins, carbohydrates, fats, and micronutrients. About 20 feet long and one inch in diameter, this coiled tube is connected to the stomach on one end and the large intestine, also known as the colon, on the other. The first section of the small intestine (the duodenum) completes the digestion phase, using enzymes from the pancreas and bile from the gallbladder to break down the food (see Supporting Players). The food then moves into the middle section (the jejunum) where the bulk of nutrients are absorbed into the bloodstream. The third and final section (the ileum) is where the last of the absorbable products of digestion, including bile acids and vitamin B12, are taken in to the body.

➧➧ Large Intestine. Anything not yet digested and absorbed moves on to the large intestine, or colon. This material most commonly includes dietary fiber from fruits, veggies, beans, whole grains, and nuts. The large intestine is a muscular tube that is three times wider than the small intestine but only about five feet long. From where it meets the small intestine, the colon wraps up the right side of the body, across the top just below the ribcage, and down the left side, where it connects to the rectum. The remnants of digested food as well as unabsorbed fluids and dead cells from the lining of the intestines enter the large intestine as a slurry. The large intestine absorbs most of the water, changing the waste from liquid to solid. The resulting stool is then stored until it’s emptied into the rectum. It typically takes about 36 hours for stool to pass through the large intestine.

A complex organization of bacteria in the large intestine (commonly called the “gut microbiota”) feed on material such as fiber, producing beneficial compounds (and sometimes harmful ones) that can impact our health. Keeping these important bacteria healthy and wellfed with plenty of fiber is important for our health.

In addition to housing these important microorganisms, the gut produces many hormones and is a major part of our immune system. “We don’t yet fully understand all the important roles the GI tract plays beyond digestion,” says Plaut.

Supporting Players

Several organs help the GI tract complete its amazing job of turning food into absorbable nutrients and waste.

Liver. The largest organ in the body, weighing in at about three pounds, your liver performs more than 500 vital functions. You cannot survive without it. All the blood from the stomach and intestines flows through the liver before it passes to the rest of the body. The liver metabolizes drugs and toxic substances into forms that are nontoxic, which allows the body to use or eliminate them. It also makes certain blood proteins, produces cholesterol to transport fats through the body, helps maintain blood sugar balance, and produces factors that regulate blood clotting. Bile acids, compounds that help break down the fats in the foods you eat, are produced by the liver.

Gallbladder. The gallbladder stores and releases bile acids, the compounds produced by the liver to break down fats in the foods and beverages you consume. When you begin eating fat-containing foods, the gallbladder releases the stored bile acids into the biliary duct, which delivers them to the small intestine. There, they meet and mix with the food to facilitate digestion. After you eat fat-rich foods, the gallbladder is depleted of bile acids and begins to refill.

Pancreas. The pancreas is intimately involved in digestion and in regulating the body’s metabolism of glucose. During digestion, the pancreas releases three different types of digestive enzymes into the small intestine to break down foods: lipases break down fats into fatty acids, proteases break down proteins into amino acids and protect the intestines from germs, and amylases break starches into glucose. The pancreas also releases bicarbonate into the small intestine to neutralize the acid coming from the stomach. Without this step, the digestive enzymes will not be able to function optimally.

In addition to digestive enzymes, the pancreas also releases hormones into the bloodstream to regulate nutrient metabolism. These include insulin, which is necessary to move blood glucose into the body’s cells to be used for energy or stored. Glucagon signals the liver to release stored glucose if blood sugar is too low. Gastrin signals the stomach to make gastric acid. Amylin helps control appetite and the rate of stomach emptying.

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Simple But Essential

Your gallbladder functions as a storage unit for bile, a liquid produced in the liver that helps you digest fats. “When you eat fatty foods, the small intestine secretes a hormone called cholecystokinin,” says Mount Sinai gastroenterologist Brijen J. Shah, MD. “Cholecystokinin causes the gallbladder to contract and squeeze bile into the small intestine, where the breakdown and absorption of fat occurs. Gallstones can prevent bile from reaching the small intestine.”

Gallstones range in diameter from a few millimeters to several centimeters. It is unclear why the stones form, but they may be caused by an imbalance in the amount of cholesterol or bilirubin (a waste product formed by the liver as it breaks down old red blood cells) contained in bile. How well the gallbladder empties is another possible factor—if this doesn’t happen properly, bile becomes too concentrated, which may contribute to gallstone formation.

As well as age and gender, certain health conditions—including diabetes, obesity, and Crohn’s disease (a type of inflammatory bowel disease) increase the risk of gallstones. Rapid weight loss (for example, after bariatric surgery) and some medications (including the diuretics that are used to treat high blood pressure and heart failure) also make you more susceptible to gallstones.

Gallstone Complications May Be Serious

Bile exits the liver through ducts that drain into the common hepatic duct. This duct joins the cystic duct, which carries bile to and from the gallbladder. Both the common hepatic duct and the cystic duct lead to the common bile duct, through which bile travels to the small intestine.

If a gallstone gets caught in the cystic duct, bile may be trapped in the gallbladder, which may result in acute cholecystitis (inflammation of the gallbladder). Acute cholecystitis can cause severe pain in the upper right abdomen, nausea, vomiting, and fever. It also may lead to serious complications, including infections, permanent scarring, and rupture of the gallbladder, so if you experience symptoms alert your doctor immediately. “Keep in mind that older adults don’t always have the obvious symptoms of acute cholecystitis,” Dr. Shah adds. “They may not have any pain—instead, they may feel fatigued and lose their appetite.” Severe pain also may result if a gallstone blocks the common bile duct. “Jaundice—a yellowish tint to the skin and whites of the eyes—may develop, too,” Dr. Shah says.

The pancreas also produces digestive enzymes that travel to the small intestine through the pancreatic duct, which joins the common bile duct as it enters the intestine. If a gallstone becomes lodged in the common bile duct, digestive enzymes may be trapped in the pancreas, causing inflammation of the pancreas (pancreatitis). This typically causes intense pain that requires hospitalization.

Treating Symptomatic Gallstones

More troublesome gallstones that are small and composed of cholesterol can be broken up with medications, but months or even years of treatment may be required. This means that surgery to remove the gallbladder is the most usual treatment for gallstones that persistently cause problems.

Gallbladder removal is typically performed using a minimally invasive technique (“keyhole surgery”) through tiny incisions in the abdomen. “You should be able to go home the same day as your surgery, and recovery is generally fast, though you’ll need to avoid heavy lifting for a few weeks,” Dr. Shah explains. Your body will function perfectly well without a gallbladder, since bile can drain into the intestine through the common hepatic duct. “However, keep in mind that it is still possible for gallstones to develop in the bile ducts after gallbladder removal, and these also can cause blockages,” Dr. Shah adds. You may be able to reduce the risk of recurrence by cutting back on fatty foods.

If you’ve had repeated episodes of cholecystitis or previous abdominal surgery, you may have internal scarring that makes open surgery necessary to remove your gallbladder. This typically requires a hospital stay of up to one week, followed by six to eight weeks for recovery.

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